Zhang Xin, Yang Dingyi, Jiang Yong, Huang Luo, Wang Can, Tao Dan, Liu Xianfeng, Lei Yongyang, Wu Yongzhong, Zhou Wei
Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People's Republic of China.
J Inflamm Res. 2021 Aug 28;14:4205-4215. doi: 10.2147/JIR.S328955. eCollection 2021.
We sought to compare the symptomatic radiation pneumonitis (RP) in lung cancer patients treated with helical tomotherapy (HT) versus intensity-modulated radiotherapy (IMRT), and examine the predictive value of circulating lymphocyte subsets affecting the occurrence of RP.
Circulating lymphocyte subsets, clinical characteristics, dosimetric parameters and pulmonary function were collected from 130 lung cancer patients treated with HT (n = 53) or IMRT (n = 77) from 2016 through 2020. Symptomatic RP was compared between groups. Binary logistic regression was used to identify predictors of RP.
The IMRT group had larger planning target volume (319.9 vs 240.8 cc, P = 0.041); more ECOG performance status 0-1 (96.1% vs 79.2%, P = 0.002); more stage III-IV disease (94.8% vs 37.6%, P = 0.028); and more combined systemic therapy (85.7% vs 69.8%, P = 0.022). Grade ≥2 RP were comparable between IMRT and HT groups (16.9% vs 15.1%, P = 0.785). For stage III-IV disease, IMRT was associated with lower lung V10 (31.9% vs 35.8%, P = 0.047) and lower incidence of grade 5 RP (0% vs 9.1%, P = 0.018). All lymphocyte subsets reduced after radiotherapy. The decrease degree of total T cell count and CD4 T cell count were larger after IMRT than HT (P = 0.043, P = 0.021). In univariate analysis, the smoking status, lower baseline FEV1, and higher total T cell count, higher CD8 T cell count, lower total B cell count, lower CD4/CD8 ratio after radiotherapy were associated with the development of grade ≥2 RP. The higher CD8T cell count after radiotherapy was the only risk factor associated with grade ≥2 RP in multivariable analysis (OR 1.003; 95% CI: 1.000-1.005; P = 0.044).
IMRT was associated with lower lung V10 and less grade 5 RP than HT for stage III-IV lung cancer. Higher CD8 T cell count after radiotherapy was associated with an increased risk of RP. HT may better preserve total T cell and CD4 T cell than IMRT.
我们旨在比较接受螺旋断层放疗（HT）与调强放疗（IMRT）的肺癌患者的症状性放射性肺炎（RP），并研究循环淋巴细胞亚群对RP发生的预测价值。
收集了2016年至2020年期间接受HT（n = 53）或IMRT（n = 77）治疗的130例肺癌患者的循环淋巴细胞亚群、临床特征、剂量学参数和肺功能。比较两组间的症状性RP。采用二元逻辑回归分析确定RP的预测因素。
IMRT组的计划靶体积更大（319.9 vs 240.8 cc，P = 0.041）；更多患者的东部肿瘤协作组（ECOG）体能状态为0 - 1（96.1% vs 79.2%，P = 0.002）；更多患者为III - IV期疾病（94.8% vs 37.6%，P = 0.028）；以及更多患者接受了联合全身治疗（85.7% vs 69.8%，P = 0.022）。IMRT组和HT组≥2级RP的发生率相当（16.9% vs 15.1%，P = 0.785）。对于III - IV期疾病，IMRT组的肺V10更低（31.9% vs 35.8%，P = 0.047），5级RP的发生率更低（0% vs 9.1%，P = 0.018）。放疗后所有淋巴细胞亚群均减少。IMRT后总T细胞计数和CD4 T细胞计数的下降程度大于HT（P = 0.043，P = 0.021）。单因素分析中，吸烟状态、基线FEV1较低、放疗后总T细胞计数较高、CD8 T细胞计数较高、总B细胞计数较低、CD4/CD8比值较低与≥2级RP的发生相关。多因素分析中，放疗后较高的CD8 T细胞计数是与≥2级RP相关的唯一危险因素（比值比1.003；95%置信区间：1.000 - 1.005；P = 0.044）。
对于III - IV期肺癌，IMRT与HT相比，肺V10更低，5级RP更少。放疗后较高的CD8 T细胞计数与RP风险增加相关。与IMRT相比，HT可能更好地保留总T细胞和CD4 T细胞。
